Haemodialysis for lithium poisoning: Translating EXTRIP recommendations into practical guidelines
Nicholas A Buckley1, Sonia Cheng2,3, Katherine Isoardi4
1Pharmacology, University of Sydney, Sydney, Australia.
British Journal of Clinical Pharmacology
|January 9, 2020
Summary
Applying Extracorporeal Treatments in Poisoning (EXTRIP) criteria to lithium toxicity is too broad. Modifications can better target haemodialysis for patients at risk of neurological sequelae.
Area of Science:
- Nephrology
- Toxicology
- Pharmacology
Background:
- Lithium is a common treatment for bipolar disorder.
- Lithium toxicity can lead to severe neurological complications.
- The Extracorporeal Treatments in Poisoning (EXTRIP) Workgroup developed criteria for managing poisoning.
Purpose of the Study:
- To evaluate the impact of applying EXTRIP Workgroup criteria to lithium toxicity cases.
- To assess the effectiveness of haemodialysis in lithium poisoning.
- To develop a predictive method for lithium concentration at 36 hours.
Main Methods:
- Retrospective analysis of medical records for lithium poisoning patients (≥1.3 mmol/L).
- Evaluation of patient data against EXTRIP criteria.
- Development and validation of a nomogram using Estimated Glomerular Filtration Rate (eGFR) to predict lithium concentration.
Main Results:
- 2.5% of patients received haemodialysis; 6.7% experienced neurological sequelae.
- Applying EXTRIP criteria would have indicated dialysis for 58% of patients.
- A developed nomogram accurately predicted lithium concentration at 36 hours for chronic toxicity.
Conclusions:
- EXTRIP criteria for lithium toxicity are overly broad.
- Modifications to EXTRIP criteria can help target haemodialysis to high-risk patients.
- A predictive nomogram aids in managing chronic lithium poisoning.
Related Concept Videos
01:30Extracorporeal Removal of Drugs: Peritoneal Dialysis and Hemodialysis
307
Patients with end-stage renal disease (ESRD) or those experiencing drug overdose often require extracorporeal methods to eliminate accumulated drugs and metabolites. Hemoperfusion, hemofiltration, and dialysis are the primary techniques to rapidly remove harmful substances without disrupting the patient's fluid and electrolyte balance. For those with compromised renal function, dosage adjustments of concurrent medications may be necessary during extracorporeal drug removal.Dialysis is a process...
307
01:25Extracorporeal Removal of Drugs: Hemoperfusion and Hemofiltration
148
Hemoperfusion and hemofiltration are critical techniques in medical treatments to eliminate accumulated drugs, metabolites, and electrolytes from the bloodstream. These methods are particularly vital in cases of accidental poisoning and drug overdose.Hemoperfusion involves passing blood through an adsorbent material to remove unwanted substances. The main adsorbents used in hemoperfusion include activated charcoal and Amberlite resins. Activated charcoal can adsorb both polar and nonpolar...
148
01:20Acute Kidney Injury V: Interprofessional Care
234
Acute Kidney Injury (AKI) requires a collaborative healthcare approach to restore renal function and prevent complications. Essential management strategies involve monitoring fluid and electrolyte balance, adjusting medications, initiating dialysis when necessary, and providing nutritional support.Fluid and Electrolyte ManagementFluid Monitoring: Regularly monitoring body weight, central venous pressure, and urine output helps detect fluid imbalances early. Patient intake and output are...
234
01:22Acute Kidney Injury VI: Nursing Management
317
Acute Kidney Injury (AKI) results in an inability to maintain fluid, electrolyte, and acid-base balance. Effective nursing management is critical in improving patient outcomes and includes comprehensive patient assessment and targeted interventions.Comprehensive Patient AssessmentA detailed history collection is essential, focusing on any recent infections, nephrotoxic medication use, or chronic conditions such as hypertension and diabetes that may contribute to AKI. During the physical...
317
01:25Hemodialysis III: Nursing Management
631
The nursing management of a patient undergoing hemodialysis includes several critical steps, starting with a thorough assessment before the procedure.Before the Hemodialysis ProcedureFirst, record the patient's vital signs—blood pressure, heart rate, respiratory rate, and temperature—to establish a baseline. This baseline is essential for detecting conditions such as hypotension that could impact the patient's response to dialysis. Document the patient's pre-dialysis weight, as this...
631
01:26Enhanced Elimination of Poison
805
Poison can be effectively removed from the gastrointestinal (GI) tract through various decontamination procedures.
Antidotes serve a crucial role in counteracting the effects of poison by inhibiting enzymes responsible for producing harmful drug metabolites. In some cases, these toxic metabolites can be neutralized by endogenous cosubstrates, which are maintained at specific concentrations to prevent interaction with cellular macromolecules and subsequent cell death.
Renal excretion is the...
Antidotes serve a crucial role in counteracting the effects of poison by inhibiting enzymes responsible for producing harmful drug metabolites. In some cases, these toxic metabolites can be neutralized by endogenous cosubstrates, which are maintained at specific concentrations to prevent interaction with cellular macromolecules and subsequent cell death.
Renal excretion is the...
805